Coronavirus: Should People With Diabetes Be Worried?

coronavirus and diabetes - what is the coronavirus - symptoms of coronavirus - 2019 Novel Coronavirus - should i be worried about the Coronavirus if i have diabetes

Update, March 12, 2020: We urge all One Drop users to take appropriate precautions. Be smart. Be safe. Take care of yourself and take care of each other. For more information, please read Coronavirus and Diabetes: 8 Ways to Stay Safe.

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This article originally published by Felix Shaw from Simply Diabetic

I have a degree in microbiology and a research masters in virology from the University of Leeds. I’ve decided to explain coronavirus as simply as I can, as well as give my take on whether we as people with diabetes should be concerned.

Am I worried? No. But I am aware.

What Is Coronavirus?

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from common cold to more severe diseases such as Severe Acute Respiratory Syndrome (SARS-CoV) (WHO).

The majority of people will get infected with a common human coronavirus at some point in their lives, with the illness only lasting for a short period of time.

Human coronaviruses can cause lower-respiratory tract illnesses, such as pneumonia or bronchitis. This is more common in those with weakened immune systems, infants and the elderly. (CDC)

Coronaviruses are zoonotic, meaning they are transmitted between animals and humans.

Why Is This Coronavirus Making Headlines?

The newly emerged coronavirus, 2019-nCoV, is a novel coronavirus, meaning it’s a new strain that has not been previously identified in humans. As with any new strain of virus, our understanding changes rapidly as assessments are made from current and new cases.

Coronavirus vs. the Flu

So far, the 2019-nCoV has led to over 20,000 illnesses and over 600 deaths. While this may be a scary figure to see, especially since this virus is relatively new, these figures don’t compare with the flu (influenza).

In the U.S, the flu has already caused an estimated 19 million illnesses, 180,000 hospitalizations and 10,000 deaths this season alone (CDC).

The difference between the flu and the newly identified coronavirus is that seasonal flu has been studied for many decades. Despite the danger posed by the virus, we do know a lot about flu viruses and what to expect each season.

In comparison, little is known about the 2019-nCoV due to its very recent emergence. As a result, more time is needed to see how far it will spread and how many deaths it will cause.

How Does the Coronavirus Spread?

The 2019-nCoV can be transmitted from person to person, usually after close contact with someone who’s infected.

For confirmed cases of 2019-nCoV, reported illnesses have ranged from people with little to no symptoms, to people being severely ill and dying. The identified symptoms appear within 2-14 days after exposure.

What Are Coronavirus Symptoms?

Coronavirus symptoms can include:

  • Fever
  • Cough
  • Shortness of breath
  • Runny nose
  • Sore throat

According to the CDC, older people and people with pre-existing medical conditions (such as diabetes and heart disease) appear to be more vulnerable to becoming severely ill with the virus.

Coronavirus and Diabetes

Being unwell, particularly from an infection, can raise your blood sugar levels significantly. As part of your body’s defense mechanism for fighting illness, your liver will dump more glucose into the bloodstream, regardless of whether you’re eating less than usual.

The body’s natural solution to this is to produce more insulin to counteract this rise in blood sugar. But for those of us with diabetes, our body is unable to do this.

Having diabetes makes us all more vulnerable to infection, both bacterial and viral. This is because an elevated blood glucose provides an environment for these types of microorganisms to thrive and multiply.

Not only that, but elevated blood glucose interrupts the ability of our white blood cells to fight infection, making it harder for us to overcome an illness and thus increasing the likelihood for complications to occur. This is why it’s so important to keep a close eye on your blood glucose when you’re unwell.

A study from the University of Maryland School of Medicine (UMSOM) and the Johns Hopkins University School of Medicine investigated how diabetes contributes to mortality from MERS-CoV infections (a coronavirus).

In a mouse model, they discovered that mice with diabetes infected with MERS-CoV exhibited a delayed and prolonged inflammatory response in the lung compared to mice without diabetes.

Diabetic mice had low levels of inflammatory cytokines and fewer inflammatory macrophages and T-cells (all of which are involved in the body’s response to infection). 

These findings indicate that the increased severity of MERS-CoV infection in patients with diabetes is likely due to a malfunction in the body’s response to infection.

This study was carried out in relation to the emergence of MERS-CoV in Saudi Arabia in 2012, which led to more than 800 deaths. Clinical evidence has pointed at diabetes as a major risk factor in patient mortality.

Respiratory infections accompanied by a fever, such as those caused by coronaviruses, can cause your insulin requirements to rise and lead to an increase in insulin resistance.

As a result, basal insulin requirements may rise. A severe infection accompanied by a high fever can also lead to you becoming dehydrated with incredibly high blood glucose levels. It is in these situations that the risk of ketones appearing becomes more likely. The presence of ketones in the blood is an indicator that you’re not receiving enough insulin.

When insulin (the key) is not available, glucose is unable to enter the cells of the body to be used for energy. Instead, it remains in the blood, where it continues to increase in concentration.

As the body is unable to use glucose as an energy source, it looks to the fat reserves. When fat is used as the energy source, chemicals known as ketones are released into the blood. Diets such as the Ketogenic diet work by placing the body in a mild state of ketosis.

In the case of people with diabetes, an overall lack of insulin (both basal and bolus) will lead to dangerously high levels of ketones in the blood, which causes blood to become acidic.

I’m sure several gruesome images pop to your mind when you imagine your blood as acid. Rather than digesting your body from the inside out, it throws off the ‘biochemical environment’ in your body required for optimum function.

The end result of being in this state is ketoacidosis - a serious condition that leads to coma and death.

Should You Be Concerned If You Have Diabetes?

As someone who lives with type 1 diabetes, I am not worried about the emerging 2019-nCoV. The UK (where I live) has robust infection control measures in place to minimize the spread of such infections and to respond immediately to new cases.

Infection is something that all people with diabetes should be aware of, but for the time being I’m not going to lose any sleep over dramatic headlines the media choose to publish.

 

 

References

https://www.nature.com/articles/d41586-020-00236-9
https://www.who.int/news-room/q-a-detail/q-a-coronaviruses
https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/illness
https://www.myomnipod.com/poddertalk/patient/2018-12-20/managing-diabetes-when-youre-sick
https://www.sciencedaily.com/releases/2019/10/191018181045.htm
https://www.sciencemediacentre.org/expert-reaction-to-new-estimates-of-infection-rate-of-novel-coronavirus/
https://www.nhs.uk/conditions/diabetic-ketoacidosis/
https://www.cdc.gov/coronavirus/about/symptoms.html
https://www.wired.co.uk/article/china-coronavirus
https://www.livescience.com/new-coronavirus-compare-with-flu.html
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Mary Elizabeth Adams
Feb 10, 2020

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